Thematic Analysis of Military Medical Ethics Publications from 2000 to 2020 – A Bibliometric Approach

Zack Bailey*, Peter Mahoney, Marina Miron, Martin Bricknell

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction
There has been external criticism of the compliance of military health personnel with internationally agreed principles in military medical ethics (MME). In response, a number of authors have called for clarity on the principles and topics within the domain of military medical ethics. This complements an increased acknowledgement of the need for education in MME for military health personnel. Our paper utilizes bibliometric techniques to identify key themes in MME to inform the development of a curriculum for this subject.

Materials and Methods
We designed a search strategy to find publications over the period 01 Jan 2000 – 31 Dec 2020 in the domain of MME from the three databases, PubMed, Web of Science, and Scopus, using the search string (ethic* OR bioethics* OR moral*) AND military AND (medic* OR health*). We obtained a total of 1115 publications after duplication removal. After exclusion based on topic, year, and study design, we analyzed a total of 633 publications using Scopus’s embedded analysis tool and the software VOSViewer. We generated a co-occurrence word map from the abstracts of each of the publications. We deduced themes of MME based on the clusters shown in the word map, and we categorized each publication into one of these themes to analyze the change of themes over time.

Results
We observed a 10-fold increase in annual publications on MME between 2000 and 2020. The majority of papers were written by US (72%) and UK (13%) authors, though a total of 15 countries were represented. After using VOSViewer to identify co-occurring key words in titles and abstracts from these publications, 9 themes were identified: Biomedical Research, Care to Detained Populations, Disaster/Triage, Mental Health, Patient-Focused Foundations, Technology, Dual Loyalty, Education/Training, and Frameworks. The relative proportion of each of these themes changed over the study period, with Mental Health being dominant by the end.

Conclusions
This study has identified key themes that might inform the development of a curriculum for teaching MME. It is noticeable that the majority of themes cover MME from the perspective of professional practice on military operations; noting, the research and technology themes also pertains to the generation of knowledge for military operations. There was a limited number of publications covering practice in the non-deployed or garrison settings, and these were codified under the themes of “framework” and “dual-loyalty”. The results are skewed towards English speaking countries and exclude non-academic publications. Further work will search for other open-source information and non-English publications. To our knowledge, this exploratory bibliometric analysis on MME in academic literature is the first of its kind. This paper has demonstrated the use of bibliometric techniques to evaluate the evolution of knowledge in MME, including the identification of key themes. These will be used to support further work to develop a curriculum for the teaching of MME to military medical audiences.
Original languageEnglish
JournalMilitary Medicine
DOIs
Publication statusPublished - 2 Aug 2021

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